Regarding acute appendicitis in a pregnant woman at 24 weeks gestation, which statement about the clinical features and management is most accurate?
- A The appendix remains in its normal position at McBurney's point throughout pregnancy
- B MRI is contraindicated in all trimesters of pregnancy
- C The appendix is displaced superiorly and laterally by the gravid uterus; pain may be periumbilical or right upper quadrant; laparoscopic appendicectomy is safe and preferred ✓
- D Conservative antibiotic management is always preferred to surgery to protect the fetus
Correct answer: C. The appendix is displaced superiorly and laterally by the gravid uterus; pain may be periumbilical or right upper quadrant; laparoscopic appendicectomy is safe and preferred
Explanation
The gravid uterus progressively displaces the caecum and appendix superiorly and laterally, so by the second trimester (20–24 weeks) the appendix may lie at or above the umbilicus, and pain may localise to the right upper quadrant or flank — atypical for appendicitis. Laparoscopic appendicectomy is safe in pregnancy, recommended by SAGES guidelines for all trimesters, with appropriate uterine displacement. MRI (without gadolinium) is safe in all trimesters and is preferred over CT. Conservative management carries high risk of perforation in pregnancy.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.